Aortic Valve Replacement: Open
What is an open aortic valve replacement?
An open, invasive aortic valve replacement is a surgery to replace a poorly working
aortic valve with an artificial valve. The heart has 4 valves. These valves help blood
flow through the heart and out to the body by promoting forward flow and preventing
backflow. The aortic valve lies between the left pumping chamber of the heart (ventricle)
and the aorta. The aorta is the blood vessel that carries blood away from the heart
to the rest of the body.
Under certain circumstances, your valve can stop working well. Your surgeon may use
an artificial valve to replace your poorly working valve. This will ensure that blood
can exit the heart and flow out to the body normally. The surgery is called "open"
because it uses a traditional type of incision and separation of your breastbone (sternum)
to expose your heart. This incision is larger than those in minimally invasive types
of aortic valve replacement surgery.
Why might I need an open aortic valve replacement?
When your aortic valve isn't working well, you may need it fixed or replaced. Aortic
valve stenosis or aortic valve regurgitation are 2 different types of problems that
might need a valve replacement.
Aortic stenosis. Your valve can't open fully. This means less blood is able to exit your heart.
Aortic regurgitation. Your valve is leaky. Some blood leaks backward through the valve instead of moving
out to the rest of your body.
In both of these cases, you may need to have your aortic valve replaced. A poorly
working aortic valve may lead to symptoms, such as:
If these symptoms are present or get worse, surgery may be needed. Your healthcare
provider may recommend the surgery based on testing, such as an echocardiogram (ultrasound
of the heart) even if you don’t have significant symptoms. Surgery is most effective
if symptoms are not too advanced.
Both aortic stenosis and aortic regurgitation can result from general aging of the
valve. Other causes of aortic valve disease include:
Heart birth defects such as a bicuspid aortic valve
Bacterial infection of the heart valve
A tear in the aorta
Weakened, stretched aorta wall (aortic aneurysm)
Certain genetic conditions such as Marfan syndrome
What are the risks of an open aortic valve replacement?
There are certain risks with any type of surgery. Your risks will vary based on your
medical condition, your age, and other factors. Be sure to talk with your healthcare
provider about any concerns that you have.
Most people who have open aortic valve replacement will have a successful outcome.
But there are some possible risks. These include:
Irregular heart rhythms, in some cases requiring a pacemaker
Blood clots leading to stroke or heart attack
Complications from anesthesia
Need for more surgery
Certain things increase the risk of complications, such as:
How do I get ready for an open aortic valve replacement?
As you plan for the surgery, you and your healthcare provider will decide what kind
of valve will work best for you. Your surgeon will replace your valve with a biological
valve or a mechanical valve.
Biological valves are made mainly from pig, cow, or human heart tissue. Biological
valves don’t last as long as mechanical valves but the risk for blood clots is less.
Mechanical valves are manmade. People with mechanical valves need to take blood-thinning
medicines for the rest of their lives because of the risk for blood clots. Mechanical
valves also have an increased risk for infection.
Talk with your healthcare provider about how to prepare for your upcoming surgery.
Remember the following:
Follow any directions you're given for not eating or drinking before surgery.
Try to stop smoking before your operation. Ask your healthcare provider for ways to
You may need to stop taking certain medicines before your surgery. Follow your provider’s
instructions if you usually take blood-thinning medicine like warfarin or aspirin.
Follow your provider's instructions about when to come to the hospital before your
surgery. Ask them any questions that you have about the procedure.
You may need some routine tests before the procedure to assess your health . These
Echocardiogram, to assess your current valve
Coronary angiogram, to assess blood flow in your heart arteries
It is common to be nervous before a surgery. If needed, you can ask for medicine to
help you relax before your surgery. In most cases your surgery will proceed as planned.
But sometimes another emergency might delay your surgery for a short time.
What happens during an open aortic valve replacement?
Check with your healthcare provider about the details of your procedure. In general,
during your open aortic valve replacement:
You will be given anesthesia before the surgery starts. This will cause you to sleep
deeply and painlessly during the operation. Afterwards you won’t remember the surgery.
The surgery will take several hours. Family and friends should stay in the waiting
room, so the surgeon can update them.
Your surgeon will make an incision down the middle of your chest. To access your heart,
your surgeon will separate your breastbone.
The surgery team will connect you to a heart-lung machine. This machine will act as
your heart and lungs during the procedure.
Your surgeon will remove your current heart valve and replace it with a new valve.
The surgery team will remove the heart-lung machine.
The team will connect your breastbone back together.
The team will then sew or staple the incision in your skin back together.
What happens after an open aortic valve replacement?
In the hospital
You will start your recovery in the intensive care unit or a recovery room.
When you wake up, you might feel confused at first. You might wake up a couple of
hours after the surgery or a little later.
Most people who have aortic valve replacement notice immediate symptom relief after
The team will watch your vital signs, such as your heart rate, blood pressure, and
breathing. You will be hooked up to a monitors so the nurses can check these more
You may have a tube in your throat to help you breathe. This may be uncomfortable,
and you won’t be able to talk. The tube will be removed when you are strong enough
to breathe on your own. This is typically within 24 hours.
You may have a chest tube to drain excess fluid from your chest.
You may have small temporary pacemaker wires exiting from your chest
Bandages will cover your incision. These can often off come off in a few days.
You will feel some soreness. But you shouldn’t feel severe pain. If you have pain,
you can ask for pain medicine.
Soon after surgery, you'll likely be encouraged to get up and sit in a chair. In 1
or 2 a days, you should be able to walk with help.
You may do breathing therapy. This helps remove fluids that collect in your lungs
during and after surgery.
You'll likely be able to drink liquids once the breathing tube is removed. This is
often the day after surgery. You can have regular foods as soon as you can handle
You may need to wear elastic stockings or compression devices on your legs to help
blood circulate through your leg veins.
You'll likely need to stay in the hospital for a few days.
Make sure you have someone to drive you home from the hospital. You will also need
some help at home for a while.
You may tire easily after the surgery, but you will slowly start to recover your strength.
It may be a few weeks before you fully recover.
After you go home, take your temperature and weigh yourself every day. Tell your healthcare
provider if your temperature is over 100.4°F (38°C). Also tell them if your weight
Ask your provider about when it is safe for you to drive.
Don't lift anything heavy for a few weeks. Ask your provider about what is safe for
you to lift. Also ask when you can go back to normal activity.
Follow all the instructions your provider gives you for medicines, exercise, diet,
and wound care. Depending on the type of valve your got, you may be given blood thinners
Let all of your dentists and other healthcare providers know about your health history.
You may need to take antibiotics before certain medical and dental procedures. This
is to prevent getting an infection on your replacement valve.
Keep all follow-up appointments. You'll likely have your stitches or staples removed
at a follow-up appointment in about 7 to 10 days.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What are the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how you will get the results
Who to call after the test or procedure if you have questions or problems
How much you will have to pay for the test or procedure